fascia is alive - world massage conference · 2018. 1. 31. · fascia is alive active contractility...
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FasciaFascia isis AliveAliveActiveActive ContractilityContractility and and SensorySensory InnervationInnervation
of Human of Human MuscularMuscular ConnectiveConnective TissuesTissues
Robert Schleip PhDFascia Research Project, Applied Physiology, University of Ulm, Germany
www.fasciaresearch.de
1. 1. FasciaFascia as a as a tensionaltensional networknetwork
2. 2. FasciaFascia as a as a sensorysensory organorgan
3. Fascial 3. Fascial tonicitytonicity
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Fascial Fascial tissuestissues
Superficial & deep fascia
Perimysium & septi
Epimysium & aponeuroses
Endomysium
Huijing & Baan 2003
Lateral myo-fascial force transmission
Peter Huijing
Vrije Universiteit, Amsterdam
T. Myers: Anatomy Trains
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Vleeming A, 1995 Barker P. 2006
Tensegrity Architecture
www.intensiondesigns.com
Fukunaga 2003
Elastic recoil function of fascial elements
Classical model:
muscle fibers shorten
New findings:muscle fibers don‘t shorten;
usage of fascial recoil
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Using muscles for adjusting the ideal prestiffness (and resonsance frequency) for
maximum energy storage of fascia
1. 1. FasciaFascia as a as a tensionaltensional networknetwork
2. 2. FasciaFascia as a as a sensorysensory organorgan
3. Fascial 3. Fascial tonicitytonicity
Fascial mechanonreceptors
Already postulatedin 1899 by A.T. Still
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• Localisation • Sensitivity • Effects
Overview at www.fasciaresearch.com
• Stilwell 1957• Sakada 1974 • Vshivtseva 1988• Yahia 1992• Stecco 2006
Presence of intrafascialmechanoreceptors
Golgi Paccini Ruffini Interstitial Sisters
Simplification:
The three Italian brothers and their little sisters
Golgi Paccini Ruffini Interstitial Sisters
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GOLGIReceptors
• Respond to stimulation with a
decrease in muscular tonus
Passive stretching does not excite GTOsJami L 1992 Golgi tendon organs in mammalian skeletal muscle:
functional properties and central actions. Physiol Rev 73(3): 623-666
E. Lederman: Foundations of Manual Therapy
• Myotendinous junctions & attachment areas ofaponeuroses
• Ligaments of peripheral joints
• Joint capsules
GOLGIReceptors
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GOLGIReceptors
Therapeutic stimulation:
Slow, deep stretching
close to the attachments
maybe combined with AMPs (active movement participationsof client during manipulation)
Golgi Paccini Ruffini Interstitial Sisters
PACINIReceptors
Sensitive only to
rapid pressure changes
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PACINIReceptors
• Deep capsular layers
• Spinal ligaments
• Myotendinous junctions
• Proprioceptive feedback for movementcoordination
• Stimulation by practitioner tends toincrease local proprioceptive attentionand self-regulation
PACINIReceptors
• high velocity adjustments
• sudden pressure release techniques
• vibratory tools
• rocking, shaking, rhythmic joint compression
PACINIReceptors
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Golgi Paccini Ruffini Interstitial Sisters
RUFFINIReceptors
Specially responsive to:
tangential forces (shear)
Stimulation results in:
an inhibition of overall sympathetic activity
RUFFINIReceptors
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• Ligaments of the peripheral joints
• Dura mater
• outer capsular layers
RUFFINIReceptors
Slow melting pressure
with lateral shearing.
RUFFINIReceptors
Golgi Paccini Ruffini Interstitial Sisters
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Composition of a motor nerve
INTERSTITIALReceptors(Type III & IV)
50%: high threshhold
Other 50% are responsive even to very subtle stimulation.
INTERSTITIALReceptors(Type III & IV)
Most abundant receptor
Found almost everywhere, even inside bones.
Highest density in periosteum
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INTERSTITIALReceptors(Type III & IV)
Strong stimulation can increase vasodilation and plasma extrusion
Also used for interoception (plus proprioception?). Can function as mechanoreceptors and/or nociceptors.
Receptor sensitivity is frequently modulated byneurotransmitters .
INTERSTITIALReceptors(Type III & IV)
Work on periosteum, interosseous membranes, and other fasciae connected with bones.
Intention of re-sensitizing interstitial mechano-receptors.
Look for autonomic reactionswidening of breath & eyes, but not yet any withdrawal responses.
Golgi Paccini Ruffini Interstitial Sisters
Schleip 2008
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1. 1. FasciaFascia as a as a tensionaltensional networknetwork
2. 2. FasciaFascia as a as a sensorysensory organorgan
3. Fascial 3. Fascial tonicitytonicity
Bunker & Anthony 1995Frozen shoulder
Hasegawa et al. 1990M. Ledderhose
Kloen 1999M. Dupuytren
Knuckle padsNodular fascitisDesmoid type fibromatosisHypertrophic scar
Club footPeyronie‘s disease
IntroductionIntroduction
Pathological fascial contractures→ facilitated by myofibroblasts
Adapted from Tomasek et al. 2002
Myofibroblast development
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32 humans (25M, 7F, 17-91yrs, Ø47±23yrs)
ImmunohistochemistryMonoclonal antibody
against α-SM-actin
Digital quantificationppm of surface portion
L2L4
F.lata
F.plant.
SS-lig.
Histological examination
HistochemistryHistochemistry
100 µmPlantar fascia. Male 57 yrs.
DensityDensity of myofibroblasts in human of myofibroblasts in human fasciafascia
IH for α-SM-actin (15 photos per sample. Monte Carlo method for choice of locations)
Digital quantification of stained areas. 565 ppm
Typical lumbar fascia
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100 µmL2 lumbar fascia. Male 19 yrs. Lumbar fascia., male 19 yrs
•Frozen lumbars?
•Signs of injured lumbar fascia?
High density of contractile cellsin perimysium
Tonic
Phasic
Pharmacologicalstimulation
Adrenaline
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Control tissue
Mepyramine
Hypothesis: general joint mobility related to MFB density
Remvig L, Schleip R (unpublished)
Dupuytren contracture Systemic hypermobilityAverage
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THANK YOU
www.fasciaresearch.com
Werner Klingler MD Adjo Zorn PhD Stefanie Rankl Anne Klein